Katelyn D'Ann Walley, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2127465 Issued in TX

Practice address

1101 W Vickery Blvd
Fort Worth, TX 76104

Phone

(682) 885-6294

Fax

(682) 885-1135

NPI assigned

Aug 16, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1534377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534723200000",
    "number": "1376023564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 99283",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761990283",
            "telephone_number": "629-468-2885",
            "fax_number": "682-885-1135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 W VICKERY BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76104",
            "telephone_number": "682-885-6294",
            "fax_number": "682-885-1135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLEY",
        "first_name": "KATELYN",
        "middle_name": "D'ANN",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-16",
        "last_updated": "2018-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2127465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rafaella Izar Wallace, ANP
• Rane Perry Wallace, MS, LPC, LCDC, SAP
• Taron M Wallace, M.S., CCC-SLP
• Emily Wallen, MA, LPC
• Charles F. Waller, CRNA
• Christine Wallin, RN
• Michele L Wallis, RN
• Walls Universal Home Health & Hospice Services, Inc.
• Amanda Walls, APRN-FNP
• Kathy Diane Walls, RN, BSN

• Physical Therapy Assistant in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Physical Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.